What is cord blood and cord tissue?

Preparing for a baby involves a lot of planning - the delivery, setting up a nursery, and a whole host of other factors. But thinking about what do do with baby's umbilical cord blood or tissue is rarely discussed. But cord blood or tissue has many medical benefits.

Until recently the placenta and umbilical cord were discarded after delivery as medical waste, but now research has shown that cord blood - the blood that remains in a baby's placenta and umbilical cord after the delivery of the baby and the umbilical cord has been cut - contains a diverse mixture of different types of cells. This blood is a rich source of blood-forming stem cells known as Haematopoietic Stem Cells (HSCs). These stem cells are normally found in the bone marrow and mature into blood cells that carry oxygen to our tissues (red blood cells) and make up our immune system (white blood cells). Cord blood is also a source of unique populations of immune cells, called regulatory T-cells, which are important in controlling the immune system and may have therapeutic potential in the treatment of immune disorders. Cord tissue contains groups of cells not generally found in cord blood for which there is substantial research underway around the world.

What can cord blood or tissue be used for?

Cord blood stem cells have been used for the past 20 years to treat children and adults for a range of life threatening diseases including leukemias, lymphomas, myeloma, other serious blood disorders, and some solid tumours. Over 1,100 stem cell transplants (using stem cells collected from bone marrow, peripheral and cord blood) are carried out in Australia each year and the majority of these (over two thirds) are autologous transplants1.

Cord blood is also showing potential in regenerative medicine. This field of medical research is exploring how cord blood stem cells may be used to repair or regenerate cells to repair tissues. Among the primary applications are autoimmune diseases, such as type 1 diabetes and rheumatoid arthritis where the body’s immune system turns to destroying body tissues. Other experimental approaches are looking at the potential of cord blood stem cells to treat conditions like brain injury, spinal injury, cerebral palsy, acquired hearing loss and others. Regenerative medicine is exciting, but remains speculative and dependent on the success of research around the world.

Cord tissue is rich in many different cell types including mesenchymal stem cells (MSCs). In laboratory studies, researchers have shown that these cells can form a variety of cells including muscle cells, bone, cartilage and tendon, skin cells and even nerve cells. MSCs are of interest because they are easily and readily isolated and can be expanded in the laboratory. As such, researchers around the world are now looking at the role of these tissue-derived stem cells in emerging cellular therapies.

Although this research is still at an early stage and medical treatments are not currently available, the unique properties of these cells make them promising for future cellular therapies. There are numerous clinical studies looking at the role of MSCs in a wide variety of conditions including arthritis, Crohn’s disease, diabetes, multiple sclerosis, spinal, brain and cartilage injuries. Plus the regenerating properties of these tissue derived stem cells provide more potential to treat additional diseases like Parkinson’s, stroke and type 1 diabetes.

Clinical Trials

FDA approved clinical trials using cord blood in experimental therapies to treat cerebral palsy, brain injury and juvenile diabetes are now underway in the USA and Europe.

More than 250 infants and children diagnosed with cerebral palsy have already been treated with their own cord blood stem cells and while anecdotal reports show promising results. Parents, therapists and researchers are observing dramatic improvements in the motor and speech skills of the children with cerebral palsy, in some cases within a few days of being treated with their own cord blood. The Medical College of Georgia is now conducting the first FDA approved Cerebral Palsy clinical trial on infants and children diagnosed with cerebral palsy.

The University of Florida is conducting the first FDA approved clinical trial to evaluate using cord blood in the treatment of type 1 diabetes. Preliminary results suggest that this treatment is able to stop progression of the diabetes leading to reduced insulin insulin requirement.

In Australia, Cell Care, the largest private cord blood bank is working with Monash University (VIC) to establish a clinical trial for the use of autologous cord blood to treat cerebral palsy. Similar to the study at Duke University, Cell Care will be performing extensive pre and post infusion neurological assessments.

A second Cell Care study is looking at the development of a protocol for a trial of autologous cord blood use in Type 1 Diabetes. A grant application to support this trial is currently under review.

Banking Options in Australia

Currently, in Australia cord blood can be collected and stored in two ways.

As a public donation to a government funded, non-profit, public cord blood bank for use by anyone needing a transplant; and

Privately stored for possible future personal use. This service is only offered by private cord blood banks.

Australian parents deciding to store cord blood must choose between public or private cord blood banking. It is very important to understand the differences between the two types of bank in order to make a completely informed decision.

Public Banking

A public cord blood bank is much like a standard blood bank. Public donation allows families to offer their baby's cord blood stem cells to the public network at no cost. The donation is intended to increase the national supply of cord blood and once donated, is made available to any patient worldwide, who is in need of a cord blood transplant.

AusCord is the Australian national network of umbilical cord blood banks and cord blood collection centres. The network collects and banks cord blood from voluntary donors for anonymous use by patients needing a stem cell transplant. Only hospitals accredited with the cord blood banks are able to collect cord blood and stringent acceptance criteria apply so not every sample collected is banked. AusCord currently employs specially trained midwives to collect cord blood (during normal working hours) from a limited number of hospitals in NSW, VIC, QLD and NT. Currently there are no collection facilities in Western Australia, South Australia or Tasmania.

There are no costs charged to the parents who consent to the donation of their baby’s cord blood or the Australian patient who receives this life saving treatment. The network is funded by the Government.

Private Banking

Storing in a private bank is much like holding something in a safe. The parents retain ownership and control the destiny of their baby’s cord blood, but there is a fee associated with the collection and storage. Families choose to store their baby’s cord blood privately for many reasons, including a) having a family history of disease, b) having a baby of an ethnic minority or mixed ethnicity, where there may be a greater difficulty finding a matched donor through the public banks c) for future regenerative medicine therapies, where the child’s own stem cells will be required and d) as an insurance policy for their child’s future health. Cord blood stem cells represent a perfect match for the baby that they were collected from so the risks of rejection are eliminated. Further, subject to suitable genetic matching, privately stored cord blood can be used with a sibling or other close family member.

Private cord blood collections can take place at any time and in most hospitals Australia-wide with a network of trained obstetrician, midwives and healthcare professionals available to perform the collection.

Although it is difficult to estimate the likelihood of using stem cells, some published studies have estimated the chance of needing a stem cell transplant from any source (i.e. cord blood, bone marrow) to be:

The chance of a child (ages 0 to 21) needing a therapy using his or her own stem cells are currently about 1 in 2,700.

The chance of an individual needing stem cells (either their own or from someone else) for transplantation over the course of their lifetime, is estimated to be about 1 in 217 (ages 0-70).

These estimates do not include future therapies that may be developed.

While the probability of a child needing a transplant (eg for leukaemia) in early childhood is low, the emerging regenerative medicine technologies and clinical trials taking place with autologous cord blood support parents researching their options for the future.

Ultimately the choice between public and private banking belongs to the parents. If you are interested in collecting your baby’s cord blood, talk to your obstetrician or midwife to discuss your options.

This article was written for Kidspot, Australia's best pregnancy, labour and birth resource.